EP2535013A1 - Zange zur Gewebeversiegelung - Google Patents
Zange zur Gewebeversiegelung Download PDFInfo
- Publication number
- EP2535013A1 EP2535013A1 EP12171992A EP12171992A EP2535013A1 EP 2535013 A1 EP2535013 A1 EP 2535013A1 EP 12171992 A EP12171992 A EP 12171992A EP 12171992 A EP12171992 A EP 12171992A EP 2535013 A1 EP2535013 A1 EP 2535013A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- tissue
- electrically
- sealing plate
- seal
- jaw members
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/285—Surgical forceps combined with cutting implements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
- A61B2017/320028—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments with reciprocating movements
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/00184—Moving parts
- A61B2018/00196—Moving parts reciprocating lengthwise
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
- A61B2018/00482—Digestive system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/0063—Sealing
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/0091—Handpieces of the surgical instrument or device
- A61B2018/00916—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device
- A61B2018/00958—Handpieces of the surgical instrument or device with means for switching or controlling the main function of the instrument or device for switching between different working modes of the main function
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/146—Scissors
Definitions
- the present disclosure relates to surgical instruments and, more particularly, to a surgical instrument for luminal tissue sealing, e.g., bowel sealing.
- Electrosurgical instruments e.g., electrosurgical forceps
- Electrosurgical forceps utilize both mechanical clamping action and electrical energy to affect hemostasis by heating tissue to coagulate and/or cauterize tissue.
- Certain surgical procedures require more than simply cauterizing tissue and rely on the unique combination of clamping pressure, precise electrosurgical energy control and gap distance (i.e., distance between opposing jaw members when closed about tissue) to "seal" tissue.
- tissue to be sealed different considerations are taken into account depending on the characteristics, e.g., composition, structure and/or function, of the tissue to be sealed. For example, in order to effectively seal the bowel, it is important to consider the stresses imparted on the seal as a result of distention of the bowel as well as peristaltic reactions within the bowel.
- a forceps in accordance with one embodiment of the present disclosure, includes an end effector assembly having first and second jaw members. One (or both) of the jaw members is moveable relative to the other between a spaced-apart position and an approximated position for grasping tissue therebetween. One (or both) of the jaw members includes an opposed jaw surface having an electrically-conductive tissue sealing plate disposed thereon.
- the electrically-conductive tissue sealing plate includes a first portion configured to conduct energy through tissue grasped between the jaw members to create a main tissue seal and a second portion including a plurality of spaced-apart fingers extending from the first portion. The second portion is configured to conduct energy through tissue grasped between the jaw members to create an auxiliary tissue seal extending from the main tissue seal for reducing stress concentrations adjacent the main tissue seal.
- the first portion of the electrically-conductive tissue sealing plate defines a generally arcuate configuration.
- the electrically-conductive tissue sealing plate is disposed at a distal end of jaw member.
- the opposed jaw surface includes an electrically-conductive main seal portion, an electrically-conductive auxiliary seal portion, and an electrically-insulative tissue grasping portion.
- the forceps includes first and second switches.
- the first and second switches are selectively and independently activatable for controlling the supply of energy to the first and second portions, respectively, of the electrically-conductive tissue sealing plate.
- a forceps in accordance with another embodiment of the present disclosure, includes an end effector assembly having first and second jaw members. One (or both) of the jaw members is moveable relative to the other between a spaced-apart position and an approximated position for grasping tissue therebetween. One (or both) of the jaw members includes an opposed jaw surface. The opposed jaw surface includes an electrically-conductive tissue sealing plate disposed thereon. The electrically-conductive tissue sealing plate is configured to conduct energy through tissue grasped between the jaw members to create a tissue seal. The opposed jaw surface further includes a plurality of thermal damage elements disposed thereon. The thermal damage elements are configured to conduct energy through tissue to thermally-damage tissue adjacent the tissue seal.
- the electrically-conductive tissue sealing plate defines a generally arcuate configuration.
- the electrically-conductive tissue sealing plate and the thermal damage elements are disposed toward a distal end of the jaw member.
- the thermal damage elements are spaced-apart relative to one another.
- the opposed jaw surface includes an electrically-conductive tissue sealing portion, an electrically-conductive thermal damage portion, and an electrically-insulative tissue grasping portion.
- the forceps includes first and second switches.
- the first and second switches are selectively and independently activatable for controlling the supply of energy to the electrically-conductive tissue sealing plate and the thermal damage elements, respectively.
- a forceps in accordance with yet another embodiment of the present disclosure, includes an end effector assembly having first and second jaw members. One (or both) of the jaw members is moveable relative to the other between a spaced-apart position and an approximated position for grasping tissue therebetween. One (or both) of the jaw members includes an opposed jaw surface having an electrically-conductive tissue sealing plate disposed thereon.
- the electrically-conductive tissue sealing plate includes a first portion configured to conduct energy through tissue grasped between the jaw members to create a main tissue seal and a second portion configured to conduct energy through tissue grasped between the jaw members to create an auxiliary tissue seal extending from the main tissue seal for reducing stress concentrations adjacent the main tissue seal.
- First and second switches are operably coupled to the first and second portions, respectively, and are selectively and independently activatable for controlling the supply of energy to the first and second portions, respectively.
- the forceps may further be configured similarly to any of the above embodiments.
- One (or both) of the jaw members is moveable relative to the other between a spaced-apart position and an approximated position for grasping tissue therebetween.
- One (or both) of the jaw members includes an opposed jaw surface including an electrically-conductive main seal portion, an electrically-conductive auxiliary seal portion, and an electrically-insulating tissue grasping portion.
- the main seal portion is configured to conduct energy through tissue grasped between the jaw members to create a main tissue seal.
- the auxiliary seal portion includes a plurality of spaced-apart components and is configured to conduct energy through tissue grasped between the jaw members to create an auxiliary tissue seal for reducing stress concentrations adjacent the main tissue seal.
- the tissue grasping portion is configured to grasp tissue between the jaw members. A portion of the tissue grasping portion is disposed between the spaced-apart components of the auxiliary seal portion.
- the forceps may further be configured
- Fig. 1 is a front, perspective view of an endoscopic surgical instrument configured for use in accordance with the present disclosure
- Fig. 2 is a front, perspective view of an open surgical instrument configured for use in accordance with the present disclosure
- Fig. 3 is a front, perspective view of one embodiment of an end effector assembly configured for use with the surgical instrument of Fig. 1 ;
- Fig. 4 is top view of one of the jaw members of the end effector assembly of Fig. 3 ;
- Fig. 5A is a greatly enlarged, side, perspective view of a distal end of the jaw member of Fig. 4 ;
- Fig. 5B is an enlarged, side, perspective view of another embodiment of a jaw member configured for use with the end effector assembly of Fig. 3 ;
- Fig. 5C is an enlarged, side, perspective view of still another embodiment of a jaw member configured for use with the end effector assembly of Fig. 3 ;
- Fig. 6 is a front, perspective illustration of a portion of tissue sealed using the end effector assembly of Fig. 3 ;
- Fig. 7 is a front, perspective view of another embodiment of an end effector assembly configured for use with the surgical instrument of Fig. 1 ;
- Fig. 8 is top view of one of the jaw members of the end effector assembly of Fig. 7 ;
- Fig. 9A is a greatly enlarged, side, perspective view of a distal end of the jaw member of Fig. 8 ;
- Fig. 9B is an enlarged, side, perspective view of another embodiment of a jaw member configured for use with end effector assembly of Fig. 7 ;
- Fig. 9C is an enlarged, side, perspective view of still another embodiment of a jaw member configured for use with end effector assembly of Fig. 7 ;
- Fig. 10 is a front, perspective illustration of a portion of tissue sealed using the end effector assembly of Fig. 7 .
- distal refers to the portion that is being described which is further from a user
- proximal refers to the portion that is being described which is closer to a user
- Fig. 1 depicts a forceps 10 for use in connection with endoscopic surgical procedures
- Fig. 2 depicts an open forceps 10' contemplated for use in connection with traditional open surgical procedures.
- an endoscopic instrument e.g., forceps 10
- an open instrument e.g., forceps 10'
- different electrical and mechanical connections and considerations apply to each particular type of instrument; however, the novel aspects with respect to the end effector assembly and its operating characteristics remain generally consistent with respect to both the open and endoscopic configurations.
- an endoscopic forceps 10 is provided defining a longitudinal axis "X-X" and including a housing 20, a handle assembly 30, a rotating assembly 70, a trigger assembly 80, an actuator 90, and an end effector assembly 100.
- Forceps 10 further includes a shaft 12 having a distal end 14 configured to mechanically engage end effector assembly 100 and a proximal end 16 that mechanically engages housing 20.
- Housing 20 contains the internal working components of the forceps 10 which are not described herein but which may be found in commonly-owned U.S. Patent No. 7,156,846 .
- End effector assembly 100 is shown attached at a distal end 14 of shaft 12 and includes a pair of opposing jaw members 110 and 120. Jaw members 110, 120 are moveable between a spaced-apart position and an approximated position for grasping tissue therebetween.
- End effector assembly 100 is designed as a unilateral assembly, e.g., where jaw member 120 is fixed relative to shaft 12 and jaw member 110 is moveable about pivot 103 relative to shaft 12 and fixed jaw member 120.
- end effector assembly 100 may alternatively be configured as a bilateral assembly, e.g., where both jaw member 110 and jaw member 120 are moveable about a pivot 103 relative to one another and to shaft 12.
- forceps 10 also includes electrosurgical cable 610 that connects forceps 10 to a generator (not shown) or other suitable power source, although forceps 10 may alternatively be configured as a battery powered instrument.
- Cable 610 includes a wire (or wires) (not explicitly shown) extending therethrough that has sufficient length to extend through shaft 12 in order to provide electrical energy to at least one of the jaw members 110 and 120 of end effector assembly 100.
- Trigger 82 of trigger assembly 80 may be selectively depressed to advance a knife (not shown) between jaw members 110, 120 to cut tissue grasped therebetween.
- Actuator 90 is selectively activatable to supply electrosurgical energy to one (or both) of jaw members 110, 120, as will be described in greater detail below.
- handle assembly 30 includes fixed handle 50 and a moveable handle 40.
- Fixed handle 50 is integrally associated with housing 20 and handle 40 is moveable relative to fixed handle 50.
- Rotating assembly 70 is rotatable in either direction about a longitudinal axis "X-X” to rotate end effector 100 about longitudinal axis "X-X.”
- Moveable handle 40 of handle assembly 30 is ultimately connected to a drive assembly (not shown) that, together, mechanically cooperate to impart movement of jaw members 110 and 120 between the spaced-apart position and the approximated position to grasp tissue disposed between jaw members 110, 120.
- a drive assembly not shown
- moveable handle 40 is initially spaced-apart from fixed handle 50 and, correspondingly, jaw members 110, 120 are in the spaced-apart position. Moveable handle 40 is depressible from this initial position to a depressed position corresponding to the approximated position of jaw members 110, 120.
- an open forceps 10' including two elongated shafts 12a and 12b, each having a proximal end 16a and 16b, and a distal end 14a and 14b, respectively. Similar to forceps 10 ( Fig. 1 ), forceps 10' is configured for use with end effector assembly 100. More specifically, end effector assembly 100 is attached to distal ends 14a and 14b of shafts 12a and 12b, respectively. As mentioned above, end effector assembly 100 includes a pair of opposing jaw members 110 and 120 that are pivotably connected about a pivot 103. Each shaft 12a and 12b includes a handle 17a and 17b disposed at the proximal end 16a and 16b thereof.
- Each handle 17a and 17b defines a finger hole 18a and 18b therethrough for receiving a finger of the user.
- finger holes 18a and 18b facilitate movement of the shafts 12a and 12b relative to one another that, in turn, pivots jaw members 110 and 120 from an open position, wherein the jaw members 110 and 120 are disposed in spaced-apart relation relative to one another, to a closed position, wherein the jaw members 110 and 120 cooperate to grasp tissue therebetween.
- a ratchet 30' may be included for selectively locking the jaw members 110 and 120 relative to one another at various positions during pivoting.
- Ratchet 30' may include graduations or other visual markings that enable the user to easily and quickly ascertain and control the amount of closure force desired between the jaw members 110 and 120.
- one of the shafts e.g., shaft 12b, includes a proximal shaft connector 19 which is designed to connect the forceps 10' to a source of electrosurgical energy such as an electrosurgical generator (not shown).
- Proximal shaft connector 19 secures an electrosurgical cable 610' to forceps 10' such that the user may selectively apply electrosurgical energy to jaw member 110 and/or jaw member 120 of end effector assembly 100.
- End effector assembly 200 may be adapted for use with either forceps 10 ( Fig. 1 ), forceps 10' ( Fig. 2 ), or any other suitable surgical instrument (not shown). However, as shown, end effector assembly 200 is disposed at distal end 14 of shaft 12 of forceps 10 ( Fig. 1 ). Similar to end effector assembly 100, end effector assembly 200 includes first and second jaw members 210, 220, respectively, pivotably coupled to one another about pivot 203 and movable between a spaced-apart position and an approximated position for grasping tissue therebetween.
- end effector assembly 200 defines a unilateral configuration wherein jaw member 220 is fixed and jaw member 210 is movable relative to jaw member 220 between the spaced-apart and approximated positions.
- this configuration may be reversed, or end effector assembly 200 may be configured as a bilateral configuration, e.g., where both jaw members 210, 220 are moveable.
- each jaw member 210, 220 includes an outer jaw housing 212, 222 and an opposed, tissue-grasping surface 214, 224, respectively.
- Tissue-grasping surfaces 214, 224 of jaw members 210, 220, respectively, are formed at least partially from an electrically-insulative material.
- An electrically-conductive tissue sealing plate 300 is disposed at a respective distal end 216, 226 of each tissue-grasping surface 214, 224 such that tissue sealing plates 300 oppose one another.
- the tissue sealing plates 300 of jaw members 210, 220 are substantially similar and, thus, the tissue sealing plate of jaw member 210 is not shown or described herein to avoid unnecessary repetition.
- tissue sealing plate 300 defines a tissue sealing surface 310 that is raised relative to tissue-grasping surface 224, although tissue sealing surface 310 may alternatively be co-planar with tissue-grasping surface 224.
- tissue sealing plate 300 when tissue is grasped between jaw members 210, 220, e.g., when jaw members 210, 220 are moved to the approximated position, at least a portion of tissue is disposed between tissue sealing plate 300 of jaw member 220 and the tissue sealing plate (not explicitly shown) of jaw member 210.
- electrical energy may be conducted between the tissue sealing plates 300 of jaw members 210, 220 and through tissue to seal tissue grasped therebetween.
- Tissue sealing plate 300 may be adapted to connect to a source of electrosurgical energy in any suitable fashion.
- tissue sealing plate 300 of jaw member 220 may include an electrically-conductive flange (not shown), or other suitable feature, that extends into jaw housing 222 of jaw member 220 such that tissue sealing plate 300 may be coupled to a source of electrosurgical energy via the wires of electrosurgical cable 610 ( Fig. 1 ) that extend through shaft 12 and into jaw member 210 and/or jaw member 220 of end effector assembly 200.
- tissue sealing plate 300 includes a main seal portion 320 at a distal end 302 thereof and an auxiliary seal portion 330 at a proximal end 304 thereof, although other suitable configurations may also be provided.
- main seal portion 320 and auxiliary seal portion 330 are integrally formed, although tissue sealing plate 300 may alternatively include separate main and auxiliary seal plate sections (not shown).
- Main seal portion 320 defines a generally arcuate configuration, while auxiliary seal portion 330 includes a plurality of fingers 335, e.g., three (3) fingers 335, although greater or fewer than three fingers 335 may be provided, that extend proximally from main seal portion 320.
- auxiliary seal portion 330 are spaced-apart from one another such that a portion 228 of tissue-grasping surface 224 is exposed between each of fingers 335 and between the outer fingers 335 and main seal portion 320. Further, as best shown in Fig. 4 , fingers 335 extend proximally beyond the ends of arcuate-shaped main seal portion 320.
- auxiliary seal portion 330 of tissue sealing plate 300 may include a plurality of spaced-apart elements similar to thermal damage elements 520 of jaw member 420 of end effector assembly 400 (see Figs. 7-9A ).
- FIG. 5B shows a jaw member 220'
- Fig. 5C shows a jaw member 220".
- Jaw member 220' is similar to jaw member 220 ( Figs. 3-5A ) except that tissue sealing plate 300' is rotated 90 degrees relative to tissue sealing plate 300 of jaw member 220 (see Figs. 3-5A ) and defines an increased width that extends substantially along the length of jaw member 220'.
- Tissue sealing plate 300' is raised relative to tissue-grasping surface 224' and includes a main seal portion 320' disposed toward one lateral side of jaw member 220' and an auxiliary seal portion 330' extending from main seal portion 320' towards the other lateral side of jaw member 220'.
- Tissue sealing plate 300' may otherwise be configured similarly to, or may include any of the features of tissue sealing plate 300 ( Figs. 3-5A ), discussed above.
- Jaw member 220 is similar to jaw member 220 ( Figs. 3-5A ) except that tissue sealing plate 300" is rotated 180 degrees relative to tissue sealing plate 300 of jaw member 220 (see Figs. 3-5A ) and jaw member 220" defines an increased width, or T-shaped configuration. That is, main seal portion 320" is disposed proximally of auxiliary seal portion 330", which extends distally from main seal portion 320" towards the distal end of jaw member 220". Further, the increased width of jaw member 220" is configured to receive a tissue sealing plate 300" having an increased width thereon. Tissue sealing plate 300' may otherwise be configured similarly to, or may include any of the features of tissue sealing plate 300 ( Figs.
- jaw members 220, 220' and 220 may be suitable for use in different procedures, depending on, for example, the size or configuration of tissue to be sealed and/or other anatomical considerations.
- end effector assembly 200 is manipulated into position such that tissue "T" to be grasped and sealed is disposed between jaw members 210, 220.
- jaw members 210, 220 are moved from the spaced-apart position to the approximated position to grasp tissue "T" therebetween, e.g., via depressing movable handle 40 relative to fixed handle 50 (see Fig. 1 ).
- jaw members 210, 220 are moved to the approximated position such that at least a portion of tissue "T” is grasped between tissue sealing plate 300 of jaw member 220 and the tissue sealing plate (not explicitly shown) of jaw member 210. Thereafter, electrosurgical energy may be supplied to tissue sealing plate 300 of jaw member 220 (and/or the tissue sealing plate (not explicitly shown) of jaw member 210), e.g., via activation of actuator 90 (see Fig. 1 )) and conducted through tissue to seal tissue "T.”
- actuator 90 may include first and second switches 90a, 90b, respectively, that are selectively and independently activatable to control the supply of energy to main seal portion 320 and auxiliary seal portion 330, respectively (see Fig. 1 ).
- the resulting tissue seal includes a generally-arcuate shaped main tissue seal "M s ,” formed by the main seal portion 320 of tissue sealing plate 300 ( Figs. 3-5 ), and an auxiliary tissue seal "A s ,” formed by the auxiliary seal portion 330, e.g., fingers 335, of tissue sealing plate 300 ( Figs.
- the main tissue seal "M s ” ensures that an effective tissue seal has been created, e.g., to seal the luminal (bowel) tissue, and also helps reduce stress concentrations at the seal due to the arcuate-shaped configuration of the main tissue seal "M s ,” which helps evenly-distribute stresses across the seal.
- auxiliary tissue seal "A s " helps further reduce stress concentrations at the main tissue seal "M s " by spreading out the stresses along the auxiliary tissue seal "A s .”
- the spaced-apart fingers 335 of auxiliary tissue seal portion 330 of tissue sealing plate 300 create an auxiliary tissue seal "A s " with relatively a large seal perimeter that relieves stress concentrations across the tissue.
- main and auxiliary tissue seals “M s " and “A s ,” respectively, provide a seal configuration that is particularly advantageous with respect to luminal tissue sealing, e.g., sealing of the bowel, wherein the main tissue seal “M s " may be subject to increased pressures, e.g., during distention of the bowel and/or peristaltic reactions within the bowel.
- the reduction of stress concentrations, especially during these increased-pressure events, helps ensure that an effective tissue seal is created and maintained and increases the overall burst pressure of the seal.
- end effector assembly 400 configured for use with forceps 10 ( Fig. 1 ), forceps 10' ( Fig. 2 ), or any other suitable surgical instrument (not shown) is provided.
- end effector assembly 400 is disposed at distal end 14 of shaft 12 of forceps 10 ( Fig. 1 ).
- end effector assembly 400 includes first and second jaw members 410, 420, respectively, pivotably coupled to one another about pivot 403 and movable between a spaced-apart position and an approximated position for grasping tissue therebetween.
- End effector assembly 400 may define a unilateral configuration, as shown, or may alternatively define a bilateral configuration.
- each jaw member 410, 420 of end effector assembly 400 includes an outer jaw housing 412, 422 and an opposed, tissue-grasping surface 414, 424, respectively.
- Tissue-grasping surfaces 414, 424 of jaw members 410, 420, respectively, are formed at least partially from an electrically-insulative material.
- An electrically-conductive tissue sealing plate 500 is disposed at a respective distal end 416, 426 of each tissue-grasping surface 414, 424 such that tissue sealing plates 500 oppose one another.
- the tissue sealing plates 500 of jaw members 410, 420 are substantially similar and, thus, the tissue sealing plate of jaw member 410 is not shown or described herein to avoid unnecessary repetition.
- tissue sealing plate 500 is disposed at distal end 426 of jaw member 420 and defines a generally U-shaped, or arcuate-shaped configuration. More specifically, tissue sealing plate 500 may be raised relative to tissue-grasping surface 424 of jaw member 420, or may be co-planar with tissue-grasping surface 424. In either configuration, tissue sealing plate 500 is positioned such that, when tissue is grasped between jaw members 410, 420, at least a portion of tissue is disposed between tissue sealing plate 500 of jaw member 420 and the tissue sealing plate (not explicitly shown) of jaw member 410.
- Tissue sealing plate 500 of jaw member 420 may also include a flange (not shown), or other suitable feature, that extends into jaw housing 422 to couple tissue sealing plate 500 to a source of electrosurgical energy.
- Tissue-grasping surface 424 of jaw member 420 further includes one or more electrically-conductive thermal damage elements 520 disposed thereon and generally-positioned proximally of tissue sealing plate 500. As best shown in Fig. 7 , thermal damage elements 520 are disposed generally toward distal end 426 of jaw member 420 and extend from tissue-grasping surface 424, although thermal damage elements 520 may alternatively be co-planar with tissue-grasping surface 424 of jaw member 420. Tissue-grasping surface 414 of jaw member 410 may additionally or alternatively include thermal damage elements (not shown) disposed thereon.
- Thermal damage elements 520 are spaced-apart from one another and are adapted to connect to a source of electrosurgical energy either independently of, or in conjunction with, tissue sealing plate 500 to supply energy to tissue grasped between jaw members 410, 420 to thermally damage, e.g., damage with RF energy, at least a portion of tissue grasped therebetween.
- a source of electrosurgical energy either independently of, or in conjunction with, tissue sealing plate 500 to supply energy to tissue grasped between jaw members 410, 420 to thermally damage, e.g., damage with RF energy, at least a portion of tissue grasped therebetween.
- six (6) thermal damage elements 520 are shown in triangular-alignment, the configuration and/or quantity of thermal damage elements 520 may be varied. Further, as best shown in Fig. 8 , at least one of thermal damage elements 520 may be positioned within the arc-area defined by the arcuate-shaped tissue sealing plate 500.
- FIG. 9B shows a jaw member 420' and Fig. 9C shows a jaw member 420".
- Jaw members 420', 420" each include a generally arcuate-shaped tissue sealing plate 500', 500", respectively, and a plurality of thermal damage elements 520', 520", respectively, disposed adjacent the respective tissue sealing plate 500', 500".
- Jaw member 420' may include any of the features of jaw member 420 ( Figs. 7-9A ), discussed above, and is similar to jaw member 420 ( Figs.
- Jaw member 420" may likewise include any of the features of jaw member 420 ( Figs. 7-9A ) and is similar to jaw member 420 ( Figs. 7-9A ), except that tissue sealing plate 500" and thermal damage elements 520" are rotated 180 degrees relative to tissue sealing plate 500 and thermal damage elements 520 of jaw member 420 (see Figs. 7-9A ).
- jaw members 420, 420' and 420 may be suitable for use in different procedures, depending on, for example, the size or configuration of tissue to be sealed and/or other anatomical considerations.
- end effector assembly 400 is manipulated into position such that tissue "T" to be grasped and sealed is disposed between jaw members 410, 420.
- jaw members 410, 420 are moved from the spaced-apart position to the approximated position to grasp tissue "T” therebetween such that at least a portion of tissue "T” is grasped between tissue sealing plate 500 of jaw member 420 and the tissue sealing plate (not explicitly shown) of jaw member 410.
- electrosurgical energy may be supplied to tissue sealing plate 500 of jaw member 420 (and/or the tissue sealing plate (not explicitly shown) of jaw member 410), e.g., via activation of actuator 90 ( Fig. 1 ), and conducted through tissue to create a tissue seal "S.”
- the activation of actuator 90 ( Fig. 1 ) may also supply electrical energy to thermal damage elements 520, or thermal damage elements 520 may independently be activated, e.g., actuator 90 may include first and second switches 90a, 90b, respectively, that are selectively and independently activatable to control the supply of energy to tissue sealing plate 500 and thermal damage elements 520, respectively (see Fig. 1 ). In either configuration, thermal damage elements 520 supply energy to tissue adjacent the tissue seal "S" to thermally-damage tissue adjacent the tissue seal "S.”
- tissue seal “S” effectively seals tissue "T,” e.g., bowel tissue “T.” More specifically, tissue seal “S” defines a generally-arcuate shaped configuration that evenly distributes stresses across the seal "S,” thereby helping to reduce stress concentrations at the seal “S.”
- the thermal damage “D” to tissue adjacent the tissue seal “S” inhibits the peristaltic reaction of the tissue surrounding the tissue seal “S,” thereby reducing the stresses imparted to tissue seal “S.”
- the thermal damage “D” to tissue also limits the distention of the tissue adjacent the tissue seal “S.”
- the reduction in stress concentrations at the seal "S,” and the reduction of stresses imparted to the seal “S” helps ensure that an effective tissue seal is created and maintained and increases the overall burst pressure of the seal “S.”
- the thermal damage "D” to tissue adjacent the tissue seal "S which inhibits peristaltic reactions and limits distention, allows the tissue seal "S” to sufficiently form, e.g.,
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US13/162,814 US9615877B2 (en) | 2011-06-17 | 2011-06-17 | Tissue sealing forceps |
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Also Published As
Publication number | Publication date |
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US20210361347A1 (en) | 2021-11-25 |
US9615877B2 (en) | 2017-04-11 |
US20120323238A1 (en) | 2012-12-20 |
US20170189100A1 (en) | 2017-07-06 |
US11076907B2 (en) | 2021-08-03 |
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